Damage control orthopaedics: Variability of construct design for external fixation of the lower extremity and implications on cost

Logan, Catherine; Hess, Arthur E; Kwon, John Y.

doi:10.1016/j.injury.2015.05.003

Cited by 13 publications

(14 citation statements)

References 14 publications

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“…The use of external fixation can yield excellent stability to allow the vascular repair to be performed in a controlled environment to protect the completed vascular repair from disruption [ 5 ]. Nevertheless, the current research paid more attention to the complex lower extremity deformity correction [ 6 – 9 ], the modification for external fixation [ 10 – 12 ] or case report of the use of external fixators in fractures [ 11 ]. However, according to our knowledge, to date, there has been no published work regarding the outcome of the treatment of external fixators in lower extremity arterial injuries.…”

Section: Introductionmentioning

confidence: 99%

Management algorithm of external fixation in lower leg arterial injury for limb salvages

Jin

Zhang²,

Zhang

et al. 2022

BMC Surg

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Purpose The aim of this study is to investigate the outcome of these limb-threatening injuries through external fixation treatment and to discuss the case of patients’ functional recovery after external fixation. Methods Demographics, surgical treatment and outcomes in 88 patients with lower leg arterial injuries treated by external fixation at two trauma centers from 2009 to 2018 were reviewed. The primary outcome was the rate of successful lower leg salvage, while secondary outcomes were complications and functional recovery. Results Eighty-eight patients were identified and 80 patients (90 legs) maintained a successful lower leg salvage. The mean age was 32.7 ± 10.8 years, and 81.8% were male. The primary outcomes included the following complications: pin-tract infection (8 legs), pins loosening (4 pins), wound superficial infection (7 legs), deep infection developed osteomyelitis (3 legs), bone nonunion or bone defect (17 legs) and amputation (8 legs). The average healing time of fracture was 5.6 ± 4.3 months. The maintain of external fixation average time was 5.8 ± 3.6 months. The improvement of scores of the pain, function and quality of life in our follow-up was statistically significant. Conclusion For the lower extremity fracture patients with vascular injuries, using external fixation correctly can improve clinical outcomes and produce the improvement of pain, function and the quality of life. Level of evidence Retrospective cohort, level IV.

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Section: Introductionmentioning

confidence: 99%

Management algorithm of external fixation in lower leg arterial injury for limb salvages

Jin

Zhang²,

Zhang

et al. 2022

BMC Surg

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“…In addition, there is a growing concern about the costs of the implants and their impact on both the public and on the private health care systems. 5 In order to enable cost-efficiency studies to answer if the adoption of a given implant type is adequate, researches comparing the efficacy of different implants and taking in account several factors, such as pain, function, quality of life, and time off work, are required. 5 6…”

Section: Introductionmentioning

confidence: 99%

“…Adicionalmente, existe uma preocupação crescente com o custo de implantes e o seu impacto nos sistemas de saúde tanto públicos quanto privados. 5 Para que estudos de custo-efetividade possam responder se o uso ou a adoção de determinado tipo de implante é adequado, são necessários estudos que comparem a efetividade de diferentes implantes e considerem diversos fatores, como dor, função, qualidade de vida e o tempo de afastamento de trabalho. 5 6…”

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Função e qualidade de vida de pacientes com fratura do planalto tibial operados com placa bloqueada ou convencional: estudo comparativo

et al. 2019

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ResumoComparar resultados clínicos, funcionais e de qualidade de vida de pacientes com fratura do planalto tibial operados com placa bloqueada ou convencional e comparar os custos hospitalares dos implantes.Estudo comparativo de coortes transversal, retrospectivo, em uma série consecutiva de pacientes com fratura do planalto tibial tratados cirurgicamente entre agosto de 2015 e junho de 2016. Foram excluídos: menores de 18 anos; indivíduos incapazes de responder os questionários ou de comparecer para reavaliação; politraumatizados ou com lesões associadas no mesmo membro; pacientes não tratados com placa ou conservadoramente. Os autores compararam os custos dos implantes, a qualidade de vida (SF-12), o escore de Lysholm, a escala visual de dor e os parâmetros clínicos e radiográficos.Foram observadas 45 fraturas no período, das quais 11 foram excluídas. Dos 34 pacientes, dois não compareceram à entrevista (seguimento de 94%). O tempo de seguimento foi 15,1 ± 4,8 meses. O grupo A (placa bloqueada) incluiu 22 pacientes (69%), com custo hospitalar médio dos implantes de R$ 4.125,39 (dp = R$1.634,79/paciente). O grupo B (placa convencional) incluiu dez pacientes (31%), a um custo médio de R$ 438,53 (dp = R$ 161,8/paciente; p < 0,00001). Para os demais parâmetros avaliados, não foram observadas diferenças significativas entre os grupos, exceto por um maior degrau articular no grupo A (2,7 mm ± 3,3 mm vs. 0,5 mm ± 1,6 mm; p = 0,02; TE = 0,90).O custo dos implantes bloqueados para o tratamento das fraturas do planalto tibial é significativamente superior aos implantes convencionais, embora não tenham apresentado vantagem clínica, radiográfica, funcional ou de qualidade de vida, nos pacientes dessa amostra.

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“…Реализация такой стратегии в ряде зарубежных и отечественных клиник осуществляется с помощью тактики запрограммированного многоэтапного хирургического лечении (ЗМХЛ) [3] или по англоязычной терминологии -Damage control orthopedic [7,16,17]. Тактические задачи при этом решаются путём совершенствования способов наружного (временного) остеосинтеза на I этапе тактики [10,12] и методов внутреннего (окончательного) остеосинтеза на её III этапе [6,14]. Однако с накоплением опыта применения этой тактики при лечении пострадавших с ТСиМТ появились суждения о высокой стоимости аппаратов наружной фиксации (АНФ) и нерациональности использования тактики во всех случаях ТСиМТ, о целесообразности сужения показаний к её применению.…”

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“…Однако с накоплением опыта применения этой тактики при лечении пострадавших с ТСиМТ появились суждения о высокой стоимости аппаратов наружной фиксации (АНФ) и нерациональности использования тактики во всех случаях ТСиМТ, о целесообразности сужения показаний к её применению. И в этих рассуждениях особое место занимают переломы длинных трубчатых костей (ДТК) верхних конечностей, что и определило актуальность настоящей работы [11][12][13]. Для идентификации сравниваемых групп было проведено их сопоставление по видам и тяжести травм, прогнозу исходов, а также по виду, характеру и тяжести переломов костей верхних конечностей.…”

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New Technologies in Treatment of Fractures of the Upper Extremities in Patients With Severe Multiple and Polytrauma

Gumanenko

Khromov

Линник

et al. 2016

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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A comparative analysis of treatment results of fractures of long bones of the upper extremities was made in 172 victims with severe polytrauma. The traditional strategy of treatment was used in the first group. The new technologies such as prognostic tactics, method of Damage control orthopedics and low-invasive osteosynthesis developed by the authors were applied in the second group. The application of new technologies allowed doctors to improve the immediate and long-term results of surgery. The rate of lethality decreased in 1,6 times, incidence of complications reduced in 1,4 times. Hospital stay shortened in 2 times: for victims with favorable prognosis - on 7 days; for patients with unfavorable prognosis - on 13 days. The long-term results were studied in 154 (89,5%) patients. The common duration of treatment reduced on 30 days and the quantity of good results increased on 18,6%. The number of patients with vocational rehabilitation increased from 82,3 to 90,7%.

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Damage control orthopaedics: Variability of construct design for external fixation of the lower extremity and implications on cost

Cited by 13 publications

References 14 publications

Management algorithm of external fixation in lower leg arterial injury for limb salvages

Management algorithm of external fixation in lower leg arterial injury for limb salvages

Função e qualidade de vida de pacientes com fratura do planalto tibial operados com placa bloqueada ou convencional: estudo comparativo

New Technologies in Treatment of Fractures of the Upper Extremities in Patients With Severe Multiple and Polytrauma

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